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. 2025 May;33(5):892-902.
doi: 10.1002/oby.24262. Epub 2025 Apr 3.

Clustering of intuitive eating and psychological health identifies subgroups associated with weight loss following semaglutide

Antoine Avignon  1   2 , Jean-Baptiste Bonnet  1   2 , Jean Anitcheou  2 , Sarah Tournayre  1 , Vincent Attalin  1 , Catherine Boegner  1 , Abdulkader Jalek  1 , Dominique Jullien  1 , Camille Le Rouzic  1 , Justine Myzia  1 , Lucile Marty  1 , Youadigue Kemba  1 , Ariane Sultan  1   3 , Jean Bousquet  4   5
Affiliations

Clustering of intuitive eating and psychological health identifies subgroups associated with weight loss following semaglutide

Antoine Avignon et al. Obesity (Silver Spring). 2025 May.

Abstract

Objective: Obesity management requires personalized approaches. Using data from the Aviitam platform in France, this study aimed to do the following: 1) explore psychological and behavioral patterns through clustering techniques; 2) validate the robustness of these clusters; and 3) assess their association with weight-loss outcomes in severe obesity under semaglutide treatment.

Methods: Phase 1 included 989 adults with BMI ≥ 25 kg/m2 who completed validated questionnaires, including the Hospital Anxiety and Depression Scale (HADS) and Intuitive Eating Scale-2 (IES-2). Phase 2 validated robustness in 492 individuals. Phase 3 applied clusters to 125 individuals with BMI ≥ 40 kg/m2 who were treated with semaglutide 2.4 mg/week at Montpellier University Hospital, assessing weight-loss trajectories over 12 months.

Results: The following two clusters were identified: the Intuitive Eaters Group (IEG, n = 482); and the Emotionally Driven Eaters Group (EDEG, n = 507). The IEG exhibited lower emotional distress and higher intuitive eating scores. HADS and IES-2 distinguished clusters effectively (area under the curve, 0.95). Robustness was confirmed in Phase 2. In Phase 3, the IEG demonstrated a significantly more favorable weight-loss trajectory compared to the EDEG (p = 0.03).

Conclusions: Psychological and behavioral clusters identified through HADS and IES-2 are associated with weight loss under semaglutide treatment, suggesting the value of integrating psychological and behavioral profiling into obesity care.

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Conflict of interest statement

Vincent Attalin and Antoine Avignon were major shareholders in Aviitam in the past 2 years, the company that developed the online platform used to collect the data. Antoine Avignon, Jean‐Baptiste Bonnet, Sarah Tournayre, and Ariane Sultan declared competing interests with Novo Nordisk A/S and Eli Lilly and Company. The other authors declared no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study flowchart.
FIGURE 2
FIGURE 2
ROC curves. (A) Two sets of ROC curves; the first includes all variables, including IES‐2 and HADS scores, whereas the second illustrates the ROC curve for the combined IES‐2 and HADS scores. (B) Individual ROC curves for HADS and IES‐2. HADS, Hospital Anxiety and Depression Scale; IES‐2, Intuitive Eating Scale‐2; ROC, receiver operating characteristic. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Weight loss under semaglutide 2.4 mg/week by group (Emotionally Driven Eaters Group vs. Intuitive Eaters Group). (A) Percentage of weight loss at 3, 6, and 12 months. (B) Weight‐loss categories at 12 months post treatment initiation. **p < 0.001. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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